Method of laser cosmetic surgery

ABSTRACT

Laser surgery is utilized to perform cosmetic surgery. A quartz fiber is used to direct the laser energy to the target area for the incision, division or resection of tissue. An endoscope may be utilized in conjunction with the quartz fiber to perform the cosmetic surgical techniques. One application utilizes laser energy to eliminate glabellar frown lines and/or forehead wrinkles. Another application employs laser energy to rectify brow descent. A further application uses laser energy to perform a neck lift. In yet another application, laser energy is utilized to reduce nasolabial folds. The use of laser energy in cosmetic surgical procedures greatly reduces the size of the incision required in the skin to perform cosmetic surgical procedures, and as a result greatly reduces the risks of potential complications.

This .Iadd.is a Reissue of Ser. No. 08/477,333, filed Jun. 7, 1995, nowU.S. Pat. No. 5,807,385, which .Iaddend.is a divisional of applicationSer. No. 08/314,659, filed Sep. 29, 1994, now .Iadd.U.S. Pat. No..Iaddend.5,445,634, which is a divisional of Ser. No. 08/102,851, filedAug. .Badd.2, 1993, .[.which issued Dec. 6, 1994 as.]. .Iadd.now.Iaddend.U.S. Pat. No. 5,370,642.Iadd., which is a continuation of Ser.No. 07/766,638, filed Sep. 25, 1991, now abandoned.Iaddend..

BACKGROUND OF THE INVENTION

The field of the present invention is cosmetic surgery.

In recent years, laser technology has been utilized in a variety ofapplications in industry, surveying, communications and the medicalfield. In the field of cosmetic surgery, however, standard procedurestypically involve extensive use of scalpels for incising, dividing andresecting tissue. Depending upon the particular procedure,disadvantageous complications may result including scarring, nervedamage and reduced blood flow to the affected area which can result inskin slough.

For example, to remove glabellar frown lines (between the eyebrows) andforehead wrinkles, standard cosmetic surgical technique involves anextensive procedure called a forehead lift which entails a largeincision that extends from ear to ear over the top of the forehead. Theforehead lift is particularly disadvantageous because it opens thepatient up widely requiring the physician to stop bleeders and riskcauterizing nerves. Since this procedure creates a large thin skin flapand reduces the blood supply to the skin, there is also an increasedrisk of skin slough and alopecia (balding). An alternate procedure forremoving glabellar frown lines and forehead wrinkles is collagentreatment. However, this treatment is temporary at best and alsoinvolves a risk of allergic reaction. Moreover, collagen has beenreported to cause autoimmune disease and blindness.

SUMMARY OF THE INVENTION

The present invention is directed to a method of cosmetic surgeryutilizing laser energy to incise, divide or resect tissue as necessaryto perform a particular cosmetic surgical procedure. The use of laserenergy instead of a scalpel greatly reduces the size of the incisionnecessary to perform cosmetic surgical procedures and also significantlydiminishes the risk of complications. An endoscope with a channel fordelivering the laser transmitting means can further reduce the size ofthe incision necessary to perform cosmetic surgical procedures.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a frontal view of a human head with a small incision in theforehead to insert an endolaser for removal of glabellar frown lines andforehead wrinkles.

FIG. 2 is a lateral view of a human head with a small incision in thetemple to insert an endolaser for removal of crow's-feet.

FIG. 3 is a lateral view of a human head with a small incision in theneck to insert an endolaser for performing a neck lift.

FIG. 4 is a frontal view of a human head with a small incision in theeyelid to insert an endolaser for removal of nasolabial folds.

DESCRIPTION OF THE PREFERRED EMBODIMENTS

While the invention has application with utility and advantage in aplethora of cosmetic surgical procedures, the following will describethe invention in four such applications. All four applications utilize alaser energy source which is principally transmitted to a target areausually by, but not limited to, a quartz fiber with a 300 to 700 microndiameter and a 100 to 250 micron tip. The laser energy wavelength usedis typically, but not limited to, 532 to 1060 nm. In a speciallypreferred embodiment, a 400 micron diameter quartz fiber with a 100micron tip is utilized with a laser having a 532 nm. wavelength appearsto produce the best results. An optional means for directing the lasertransmitting means to the target area is an endolaser which is composedof a endoscope with or without a channel containing the lasertransmitting means and/or balloon retractors that allow retraction intwo directions.

FIG. 1 illustrates a frontal view of a human head with glabellar frownlines 2 and forehead wrinkles 4. The supraorbital and supratrochlearforamen and nerve courses are marked. A small incision 6 or pair ofincisions are made at or behind the hair line for the insertion of theendolaser 8. If the quartz fiber is used without an endoscope, a largerincision is required. Using hooks, retractors, a bivalve speculum, andthe endolaser or quartz fiber, a supragaleal elevation of the foreheadis undertaken.

The fusion layer of fascia is found and separated either above theperiosteum with the laser or below the periosteal layer with anelevator. Using retraction and/or a balloon around the endoscope, thecorrugator and procerus muscles are divided and/or resected with thelaser, preserving, when possible, the supratrochlear nerves. Followingthis the frontalis muscle is divided in similar fashion. Retraction maybe with a wire frame retractor. The supraorbital nerve corridor ispreserved. Fascia is used to fill any defects. If the mid-brow/glabellararea is depressed a calibrated resection of forehead and/or frontal hairbearing skin is resected and galea and skin closed. If necessary, thewound may be drained. The incision is then closed utilizing a galeal aswell as a cutaneous closure.

In males with alopecia, a similar procedure is performed, but theapproach is through a unilateral or bilateral temporal incision.

FIG. 2 depicts a lateral view of a human head with brow descent, skinover the lateral eye and crow's-feet 10. To diminish these problems, thetemple and lateral brow may be elevated. The incision lines and thesupraorbital nerve course and a vertical line extending from the lateralcanthus are marked. A small incision 6 or pair of incisions are made inthe hair of the temple for the insertion of the endolaser 8. Again, whenusing only a quartz fiber a larger incision is required.

The deep temporal fascial layer is developed using the hooks and/orretractors and/or balloon retractors. Once the avascular plane is found,the dissection under the danger area of the frontal branch of the facialnerve is performed with blunt dissection with small dissecting sponges.The fusion layer with the galea is divided and, over the frontal and/orzygomatic bone the supragaleal plane developed with the laser or asubgaleal plane developed with the elevator. The corridor of thesupraorbital nerve is avoided The fusion layer of fascia below the browis divided either in a supraperiosteal plane with the laser or bluntinstrument or in the subperiosteal plane with the elevator.

The frontalis muscle is incised three centimeters above the brow andmedial to the vertical line from the lateral canthus. A suture is placedfrom an area immediately below the brow to the temporalis fascia toachieve a predetermined elevation. Resection of skin and/or hair israrely necessary, but performed if needed. The incision is closed at thegaleal and skin levels.

FIG. 3 shows a lateral view of a human head with a small incision in theneck 6 for insertion of an endolaser 8 for performing the inventivemethod of the platysma muscle and necklift.

Markings are made for the submental incision, the course of the facialnerve, the submental foramen, the platysmal bands, and the platysmalincision. A submental incision is performed and liposuction carried outin the usual manner. Dissection is carried downward with the laser todivide the tunnels. A strip of platysma and subplatysmal fit is thenremoved in vertical fashion with the laser. The endoscope is then placedhorizontally in the tunnels overlying the platysma and with retractionfrom a balloon retractor and/or retractors, the platysma is dividedand/or bluntly undermined. A corset platysmaplasty is then formed in themidline and the submental incision closed.

The fourth example of an endolaser approach to cosmetic surgery involvesreduction of nasolabial folds. FIG. 4 shows a frontal view of a humanhead with a small incision 6 in the eyelid to insert an endolaser 8 forremoval of nasolabial folds 12. An eye protection device is placed.Incision lines and the infraorbital foramen and nerve corridor aremarked. A transconjunctival or eyelid skin incision is performedutilizing the laser or knive. Dissection is usually carried preseptallyand orbital septum divided and access obtained to the cheek. Usingeither blunt or laser dissection the nasolabial fold area is identifiedusing the endoscope, retractors, balloon retractors, instruments, andlaser. The soft tissue of the nasolabial fold areas is then suturedupward. The incisions are closed.

In contrast to previous procedures, the combination of laser andendoscope allows this procedure to be performed under direct visionthrough smaller incisions inside the eye, a cosmetically superiorsituation.

While various apparatus and methods of treatment have been described inorder to make the invention known to those skilled in the art, it shouldbe readily apparent that many more modifications of the techniquesdisclosed are possible without departing from the inventive conceptscontained herein. The foregoing description, therefore, should be takenas illustrative and not limiting in any sense.

I claim:
 1. A method of cosmetic surgery for reducing nasolabial foldscomprising:placing an eye protection device on a patient; marking aninfraorbital foramen and a nerve corridor on a portion of skin of saidpatient; performing a small transconjuctival or eyelid incision in theskin for inserting a laser transmitting means and surgical instrumentssuch as retractors, balloon retractors, elevators, and/or hooks;inserting a laser transmitting means beneath the skin; performing apreseptal dissection with laser energy from the laser transmittingmeans; dividing an orbital septum; identifying a nasolabial fold area bylaser section with the laser energy from said laser transmitting means;suturing soft tissue of a nasolabial fold upward; and closing theincision.
 2. The method of claim 1 further comprising delivering laserenergy having a wavelength ranging from 532 to 1060 nanometer from saidlaser transmitting means.
 3. A method of cosmetic surgery for reducingnasolabial folds comprising:placing an eye protection device on apatient; marking an intraorbital foramen and a nerve corridor on aportion of skin of the patient; performing a small transconjunctival oreyelid incision in the skin of a patient for inserting an endoscope witha channel containing a laser transmitting quartz optical fiber with adiameter ranging from 300 to 700 micrometer and a tip diameter rangingfrom 100 to 250 micrometer and/or surgical instruments; inserting theendolaser beneath the skin; performing a preseptal dissection with laserenergy from the endolaser; dividing an orbital septum; identifying anasolabial fold area by laser section with the laser energy from saidendolaser; suturing soft tissue of a nasolabial fold upward; and closingthe incision.
 4. The method of claim 3 further comprising deliveringlaser energy having a wavelength ranging from 532 to 1060 nanometer fromsaid endolaser.